A nurse is providing anticipatory guidance to the parents of a toddler. Which of the following should the nurse include? (Select all that apply.)

A. Reassure the patient that the result is normal; no further testing is needed is incorrect because a 1-hour glucose screen result ≥140 mg/dL is considered abnormal and requires further evaluation. Simply reassuring the patient without follow-up could miss a diagnosis of gestational diabetes mellitus (GDM).

B. Begin insulin therapy immediately is incorrect because insulin therapy is not initiated based on a screening test. A diagnostic test must confirm GDM before pharmacologic management is started. Initiating insulin without confirmation could be unnecessary and potentially harmful.

C. Schedule a 3-hour oral glucose tolerance test for diagnostic confirmation is correct because the 1-hour 50-gram glucose challenge is a screening tool. A result of 150 mg/dL is above the typical screening threshold (≥140 mg/dL), so the next step is a diagnostic 3-hour, 100-gram oral glucose tolerance test (OGTT). This test measures fasting, 1-hour, 2-hour, and 3-hour glucose levels to confirm gestational diabetes before treatment is initiated.

D. Repeat the 1-hour test tomorrow is incorrect because repeating the same screening test does not provide a definitive diagnosis and may delay appropriate diagnostic evaluation and management. The 3-hour OGTT is the standard next step after an abnormal 1-hour screen.

A. Gently assess the ear and check for redness, swelling, or drainage is correct. The infant’s symptoms, tugging at the ear, inconsolable crying, and increased pain when lying down, are classic signs of acute otitis media (ear infection). A careful, gentle assessment of the external ear and ear canal for redness, swelling, or drainage helps determine the source of pain and guides appropriate treatment.

B. Administer pain medication without further assessment is incorrect because pain management should follow an assessment to identify the underlying cause. Treating pain without understanding the source may delay diagnosis and appropriate treatment, such as antibiotics if indicated.

C. Assume the pain is generalized to the entire head is incorrect because infants often cannot verbalize pain location, but the pattern of ear tugging and positional crying provides important diagnostic clues. Making assumptions without assessment risks misdiagnosis.

D. Ask the infant to point to where it hurts is incorrect because a 9-month-old cannot reliably indicate the location of pain, making observation and gentle physical assessment essential.